Managing Ankle Fractures: Addressing Numbness, Blisters, and Muscle Atrophy - Orthopedics

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Closed fracture of the right ankle - numbness in the sole of the foot - formation of blisters?


Hello, Dr.
Shi: On June 17, 2017, I suffered a fibula fracture and tibial displacement in my right ankle.
I underwent surgery to install a plate and six screws, and I have a splint (which is open from the foot to the calf).
I placed four handkerchiefs or tissues between the bottom of my foot and the splint, but by the end of July, I developed several blisters near the five toes (which I have treated myself).
However, I still feel numbness and discomfort when my foot makes contact with the splint or the ground (without applying pressure, just resting lightly).
How can I resolve this issue?
Additionally, after the surgery, the doctor instructed me to perform rehabilitation exercises: lifting my leg 100 times while lying down, pressing my toes down 100 times, and tightening and relaxing my knees and buttocks 100 times.
I have been doing these exercises daily, but now my calf muscles feel loose, and my thigh appears to have atrophied compared to the uninjured leg.
Is this atrophy? How can I prevent it? Will normal movement after the injury heal it and restore it to normal, or will increased activity in the uninjured leg cause it to become as thin as the injured one? My calf muscles lack elasticity and are sagging.
Will they regain strength once the injury heals? Thank you for your response.

Bess, 40~49 year old female. Ask Date: 2017/08/11

Dr. Shi Guozheng reply Orthopedics


Elevating the foot and performing up-and-down movements of the ankle can help improve slight muscle atrophy.
After rehabilitation, this condition will improve.
Once the fracture has healed, weight-bearing activities can be resumed, and gradual recovery will occur.

Reply Date: 2017/08/11

More Info


Managing ankle fractures, particularly after surgical intervention, requires careful attention to various complications that may arise, including numbness, blisters, and muscle atrophy. Your situation, involving a fibula fracture and tibial displacement with the placement of a plate and screws, is not uncommon, and the symptoms you are experiencing can be addressed with appropriate strategies.


Numbness and Discomfort
The numbness and discomfort you feel in your foot, particularly near the toes, could be attributed to several factors. Firstly, the presence of blisters indicates that there may be excessive pressure or friction between your foot and the splint or the ground. This can lead to localized swelling and irritation of the nerves, resulting in numbness. Here are some steps to alleviate this issue:
1. Padding and Protection: Ensure that the area where the splint contacts your skin is well-padded. You mentioned using handkerchiefs or tissues; consider using specialized padding materials that can better absorb pressure and reduce friction.

2. Regular Monitoring: Check the blisters regularly. If they become painful, red, or show signs of infection (such as pus), it’s crucial to consult your healthcare provider for appropriate treatment.

3. Adjusting the Splint: If possible, consult your orthopedic surgeon or physical therapist about adjusting the splint. Sometimes, a different type of splint or cast can alleviate pressure points.

4. Elevation and Rest: Elevating your leg can help reduce swelling and improve circulation, which may alleviate some of the numbness.


Muscle Atrophy and Weakness
Regarding the muscle atrophy you are experiencing, it is indeed a common consequence of immobilization following surgery. When a limb is immobilized, the muscles can begin to atrophy due to disuse. Here are some strategies to combat this:
1. Physical Therapy: Continue with the rehabilitation exercises prescribed by your doctor. If you feel comfortable, you might also consider working with a physical therapist who can provide tailored exercises to strengthen your leg muscles without risking further injury.

2. Isometric Exercises: While you are still in a splint, focus on isometric exercises, which involve contracting the muscles without moving the joint. This can help maintain muscle tone.

3. Gradual Weight-Bearing: Once your doctor gives you the go-ahead, gradually increase your weight-bearing activities. This will help stimulate muscle use and promote recovery.

4. Nutrition: Ensure you are consuming a balanced diet rich in protein, vitamins, and minerals to support muscle health and recovery.

5. Active Range of Motion: As you heal, incorporate active range-of-motion exercises to maintain flexibility in your ankle and prevent stiffness.


Recovery Expectations
It’s important to understand that recovery from an ankle fracture can take time. Muscle strength and size may take several weeks to months to return to pre-injury levels, especially if the injury was severe. Your body will naturally adapt, and with consistent rehabilitation, you should see improvement.


Conclusion
In summary, managing your symptoms involves addressing the blisters and numbness through proper padding and monitoring, while also focusing on rehabilitation exercises to combat muscle atrophy. Be patient with your recovery process, and maintain open communication with your healthcare providers to ensure you are on the right track. If you have any concerns about your symptoms or recovery, do not hesitate to reach out to your orthopedic specialist for further evaluation and guidance.

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